Provider Demographics
NPI:1801035019
Name:LORI M. PROCTOR, DPM
Entity Type:Organization
Organization Name:LORI M. PROCTOR, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:MARIE PROCTOR
Authorized Official - Last Name:PROCTOR
Authorized Official - Suffix:
Authorized Official - Credentials:D,P,M,
Authorized Official - Phone:610-437-9343
Mailing Address - Street 1:3885 MECHANICSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-3321
Mailing Address - Country:US
Mailing Address - Phone:610-437-9343
Mailing Address - Fax:610-437-5997
Practice Address - Street 1:3885 MECHANICSVILLE RD
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-3321
Practice Address - Country:US
Practice Address - Phone:610-437-9343
Practice Address - Fax:610-437-5997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA08 0912546332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT30379Medicare UPIN
PA1437132628Medicare NSC